Peer-reviewed article

Association of labour epidural analgesia exposure with infant neurodevelopment: secondary analysis of a prospective cohort study.

Tao S, Chen Y, Chen S, Chen J, Qin R et al. · 10 Sept 2025

Abstract

Background Evidence regarding the safety of labour epidural analgesia for infant neurodevelopment remains scarce. We conducted a secondary analysis of the Jiangsu Birth Cohort (JBC) to assess the association between labour epidural analgesia exposure and infant neurodevelopment across five domains: cognition, receptive communication, expressive communication, fine motor, and gross motor. Methods This secondary analysis included singleton vaginal births from data prospectively collected between 1 November 2017 and 1 October 2022. At 1 yr of age, trained paediatricians assessed infant neurodevelopment using the Bayley Scales of Infant and Toddler Development Screening Test, Third Edition (Bayley-III Screening Test). Infants with raw scores below domain-specific thresholds were classified as 'emerging or at risk'. Associations between maternally self-selected labour epidural analgesia exposure and infant neurodevelopment were analysed using generalised linear models adjusted for confounders. Results Among 1811 mother-infant dyads, 1224 (67.6%) received labour epidural analgesia. Labour epidural analgesia exposure was not associated with classification as emerging or at risk in any domain (cognition: adjusted risk ratio [aRR] 1.24; 95% confidence interval [CI] 0.89-1.74, P=0.205; receptive communication: aRR 0.78; 95% CI 0.58-1.04, P=0.095; expressive communication: aRR 1.03; 95% CI 0.59-1.81, P=0.904; fine motor: aRR 0.75; 95% CI 0.38-1.50, P=0.417; gross motor: aRR 0.89; 95% CI 0.57-1.38, P=0.594). The duration of labour epidural analgesia was also not associated with neurodevelopmental outcomes. Conclusions Our findings do not support an association between labour epidural analgesia exposure and increased neurodevelopmental risk at 1 yr of age. These results provide valuable insights, although the CIs and risk ratios underscore the need for larger studies with careful interpretation of clinical significance.